Corticosteroids are synthetic hormones that mimic those naturally produced by the adrenal glands. In cancer treatment, medications like dexamethasone and prednisolone serve a dual purpose: supportive care for symptoms and side effects, and direct action against cancer cells. This broad application makes them a common component of many cancer care plans.
Reducing Inflammation and Swelling
Corticosteroids alleviate inflammation and swelling caused by cancer or its treatments, reducing pressure and improving symptoms. For instance, brain tumors or metastases can lead to cerebral edema, causing headaches, seizures, and neurological deficits. Dexamethasone reduces this swelling by decreasing blood vessel permeability around the tumor, lessening fluid accumulation and relieving intracranial pressure. Similarly, in spinal cord compression caused by tumors, steroids reduce inflammation and swelling, preserving neurological function and reducing pain. Reducing inflammation around other organs also alleviates pain and discomfort, improving overall comfort and quality of life and managing acute symptoms.
Managing Chemotherapy Side Effects
Corticosteroids also mitigate various chemotherapy side effects, improving a patient’s treatment experience. They prevent chemotherapy-induced nausea and vomiting (CINV) and are often given with other anti-sickness medications to enhance effectiveness. They can stimulate appetite, crucial for maintaining nutrition and energy during rigorous treatments, and help counteract appetite loss, improving overall well-being and therapy tolerance.
They also prevent or treat acute allergic reactions to certain chemotherapy drugs. By dampening the immune response, they make it safer for patients to receive necessary treatments that might otherwise trigger severe hypersensitivity. Additionally, they aid pain management by reducing inflammation that contributes to cancer-related pain, particularly bone or neuropathic pain.
Directly Targeting Cancer Cells
In certain cancers, corticosteroids act as direct anti-cancer drugs, distinct from their supportive roles. For example, in lymphomas and leukemias (cancers of white blood cells), corticosteroids induce apoptosis, or programmed cell death, in cancerous cells. This mechanism involves steroids binding to specific receptors within cancer cells, initiating a cascade leading to cell destruction. This makes them a fundamental part of combination chemotherapy for these blood cancers.
In multiple myeloma, a cancer affecting plasma cells in bone marrow, corticosteroids are also a key component of treatment protocols. Their ability to directly influence cancer cell survival and proliferation makes them valuable therapeutic agents. This direct cytotoxic action provides a powerful tool in combating these specific malignancies, contributing significantly to treatment effectiveness.
Common Side Effects and Management
While beneficial, corticosteroids can cause side effects varying by dosage and duration. Patients often experience increased appetite, weight gain, and fluid retention (swelling in hands, feet, or face). These effects typically subside once treatment concludes.
Mood changes are common, ranging from irritability and anxiety to euphoria or difficulty sleeping. More significant mental health issues, like severe depression or confusion, can occur with higher doses. Monitoring and communicating these changes to the healthcare team is important.
Corticosteroids can elevate blood sugar, sometimes leading to steroid-induced diabetes, requiring close monitoring, especially for those managing diabetes. They also suppress the immune system, increasing infection risk. Patients are advised to practice good hygiene and avoid crowded places to minimize this risk.
Long-term use can contribute to bone thinning (osteoporosis) and muscle weakness, particularly in the legs, making daily activities challenging. Healthcare providers often prescribe calcium and vitamin D supplements or other medications to protect bone health. Medical supervision is essential; dosages are typically tapered slowly to allow natural hormone production to resume, preventing withdrawal symptoms.